Increased angiogenesis is associated with poor prognosis of squamous cell carcinoma of the vulva

Background. Increased angiogenesis is associated with an increased risk of malignant transformation in many organs. The occurrence, characteristics and significance of angiogenesis in vulvar squamous cell carcinoma are less well known. Methods. In this study, vessel number as well as vessel size, vessel shape and vessel antibody staining intensity were determined in 23,091 vessels in CD34-stained histological specimens of 42 patients by computer-assisted quantitative image analysis methods and findings were related to tumor morphology, clinical characteristics and patient survival. Results. The 2- and 5-year survival rates were 81.1 and 64.1%, respectively. High disease stage and high histological grade indicated poor prognosis. In an age-adjusted multivariate analysis of stage, grade and extent of invasion, these variables compiled a statistically significant prognostic factor (p = 0.001). Tumor histopathological type was a prognostic factor in our study and keratinising tumors did significantly better. Large tumor size, but not depth of invasion, and spray type growth pattern also indicated poor survival. In an age-adjusted multivariate analysis of stage, grade and extent of invasion, these variables compiled a statistically significant prognostic factor (p = 0.001), but none of these variables alone proved to be an independent prognostic factor. High vessel number and increased vessel size were also significant indicators of poor survival, as were vessel characteristics: vessel number, vessel size, vessel shape and staining intensity together. Conclusion. Increased angiogenesis and altered vessel characteristics were prognostic factors in determining patient survival in this study. Analysis of angiogenesis provided new information on tumor behaviour and provided markers for survival analysis in neoplasms classified by tumor type and growth pattern.